“Health for All” in a Least-Developed Country: THE PATIENT-RETAINED MEDICAL RECORD SYSTEM

THE PATIENT-RETAINED MEDICAL RECORD SYSTEM

Patients in Lesotho are the custodians of their own medical records as contained in the health book (Bukana). This is obtained from the health institution on first consultation. The book is presented at each consultation at any of the health institutions. This health book provides a quick reference to the medical history of the patients.

Hospital-based records are available only for the in-patients, and these records are not available for follow-up visits at the outpatient departments. This system of health record-keeping is operational at all levels of care.

HEALTHCARE FINANCING AND COST RECOVERY STRUCTURE

A major issue in Lesotho as in most developing countries is inadequate funding for health services. This limits the scope of the healthcare that could be provided as well as the remuneration of health and human resources. It encourages emigration of skilled health and human resources to the more-developed countries. Provision of health services in Lesotho has multisectoral participation involving the national government (the major stake holder and financier), the Christian Health Association of Lesotho (CHAL), the private health institutions, the traditional health practitioners (the Sangomas) and international nongovernmental donor organizations.
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The Ministry of Health is the third largest in terms of government expenditure (following defense and education respectively), with an allocation of 7-9% of its annual budget. Additional sources of health financing include grants and donations from multilateral and international agencies such as the WHO and other UN agencies, the European Union (EU), the African Development Bank and the World Bank. The Medical Aid and

Insurance schemes are being explored as other sources of finance.

The relative funding of the health system in Lesotho compared to some selected African countries that have a higher development index rating is illustrated in (Table 2).
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Table 2. Health System Financing*

Health Expenditures (%) Per-Capita Health Expenditures (US $)
Country Total

Public

Private

Out-of-Pocket

Total

Out-of-Pocket

Public

Out-of-Pocket
Exp.

Exp.

Exp.

Exp.

Exp,

Exp.

Exp.

Exp.
on Health

as%of

as%of

as%of

at Official at Official

in

in
as%of

Total

Total Health

Total Health

Exchange Exchange

Int’l

Int’l
GDP

Exp.

Exp.

Exp.

Rate

Rate

Dollars

Dollars
on Health
Ghana 3.1

47.0

53.0

53.0

11

6

21

24
Lesotho 5.6

72.6

27.4

27.4

28

8

73

27
Nigeria 3.1

28.2

71.8

71.8

30

22

10

25
South Africa 7.1

46.5

53.5

46.3

268

124

184

183
Swaziland    3.4

72.3

27.7

27.7

49

13

86

33
exp.: expenditures; * Culled from The World Health Report, 2000; Health Systems: Improving Performance. Geneva: World Health
Organization, 2000

The government, through its Ministry of Health, aims at recovering 15-20% of its expenditures on health from fees and other revenues. The CHAL hospitals, however, have a higher target (20-50%) of recovery. Overall, revenue from such fees is dwindling. The fees payable by patients in the various health institutions are graduated, being lowest in the health centers/clinics and highest in the CHAL hospitals. These fees are minimal and fixed and cover consultation, investigations and treatment at the government hospitals.
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MERITS OF HEALTHCARE IN LESOTHO

The structural arrangement of healthcare services in Kingdom of Lesotho demonstrates that the government has put in place a system of healthcare geared towards some specific objectives, namely:

  • Stimulating a high level of community participation in promoting and maintaining a healthy life,
  • Ensuring easy access by the nationals to good healthcare facility regardless of socioeconomic status, residence or nature of illness,
  • Ensuring that vulnerable and disadvantaged groups in the society receive adequate attention.
  • The vulnerable and disadvantaged groups include the rural residents, the elderly, pregnant women, children and the physically or mentally challenged. The fact that the health system in Lesotho is heavily subsidized by the government and hence affordable by the people cannot be over-emphasized especially when compared to some other African countries. This laudable model could be marred by inadequate and dwindling financing, poverty and the traditional beliefs, all of which are common factors in African countries. Other setbacks are inadequate health and human resources and the dearth of equipment. However, the government of Lesotho has been proactive in providing quality healthcare services at all levels.
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    To this end, there are ongoing plans to reassess community health needs with a view to expanding the activities, improving budgetary allocation and accelerating workforce development of the various divisions in the Ministry of Health and Social Welfare. In fulfillment of these, a Faculty of Health Sciences had been established at the National University of Lesotho for the training of paramedical and nursing personnel. In addition, plans are in an advanced stage to commence the construction of a medical school and a teaching hospital as part of the expansion and human resource development program of the university. UK Pharmacy

    Category: Health

    Tags: developing countries, healthcare delivery, healthcare financing, Lesotho

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